自体半腱肌腱重建距腓前韧带和跟腓韧带治疗慢性踝关节外侧不稳

Reconstruction of anterior talofibular ligament and clacanneal-fibular ligament with semitendinosus autograft for chronical ankle instability

目的对应用自体半腱肌腱解剖重建距腓前韧带和跟腓韧带治疗慢性踝关节外侧不稳的疗效进行评价。方法采用自体半腱肌腱解剖重建距腓前韧带和跟腓韧带治疗慢性踝关节不稳12例，术后将踝关节固定于中立略外翻位6周．第7周开始去石膏行踝关节功能锻炼。末次随访时采用AOFAS评分对疼痛、功能、外形进行评价。结果疼痛评分：术前0～30分，平均（20．83±7．93）分；术后30～40分，平均（32．50±4．52）分；术后较术前明显提高，差异有统计学意义（t=-7．000．P〈0．001）。功能评分：术前14～39分，平均（28．08＋9．19）分；术后40—50分，平均（48．17±3．41）分；术后较术前明显提高．差异有统计学意义（t=-9．413，P〈0．001）。外形无明显变化，手术前后评分均为10分。总分：术前26—79分，平均（58．08±16．76）分；术后80～100分，平均（90．67±6．48）分；术后较术前明显提高，差异有统计学意义（t=-9．475，P〈0．001）。结论采用自体半腱肌腱解剖重建距腓前韧带和跟腓韧带是治疗慢性踝关节外侧不稳的可靠方法。

Objective To evaluate reconstruction the anterior talofibular ligament and calcaneal-fibular ligament with semitendinosus for treatment of chronic ankle instability. Methods Twelve patients with chronic ankle instability were treated by reconstructing anterior talofibular ligament and calcaneal-fibular ligament with semitendinosus autograft. The ankle was fixed at the mild valgus position with plaster cast for 6 weeks after operation. Functional exercise was performed in the 7th week after operation. Respectively, pain, function and shape were graded according to AOAFS scoring system. Results The statistical analysis showed significantly difference （t =-7.000, P 〈0.001） between the preoperative average AOAFS scores of pain （0-30 points, 20.83±7.93 points） and the postoperative one （30-40 points,32.50±4.52 points）. The statistical analysis showed significantly difference （t =-9.413, P 〈0.001） between the preoperative average AOAFS scores of function （14-39 points, 28.08±9.19 points） and the postoperative one （40-50 points, 48.17±3.41 points）. The preoperative average scores and postopretative one of shape were 10 points without significant difference. The scores of pain, function and shape was statistically analyzed with T test. The difference between the preoperative scores （26-79 points , 58.08 ±16.76 points） and postoperative one （80-100 points,90.67±6.48 points） was statistically significant （t =-9.475, P 〈0.001）. Conclusion The treatment of chronic ankle instability with reconstruction of ATFL and CFL with semitendinosus autograft is reliable.